Systematic reviews point to strong evidence that vouchers increase utilisation of services and modest evidence that vouchers can target specific groups for service delivery and improve the quality of services, although the modest evidence largely stems from the small number of robust studies rather than a lack of impact on quality (Brody et al. 2013; Bellows et al. 2011; Gorter et al. 2013).
From a policy perspective, the results suggest that increased utilisation of health services can be achieved if service provision is scaled-up, which can be done through three different channels.
The reasons for this are, however, not entirely clear, especially whether this reflects an increased utilisation of informal services to compensate for inadequate formal services or rural carers simply managing with an overall lower level of, predominantly informal, support.
Perinatal healthcare service characteristics are presented in table 2. There was an increased utilisation of antenatal services, trained delivery attendants, institutional deliveries and postnatal services in the last 10 years.
For example, the Lady Health Worker programme which delivers a package of integrated maternal, child health and family planning services door-to-door, has recorded increased utilisation of its services in Pakistan [ 9].
There are in principle two major theories that could explain the effect of health insurance enrolment on mortality: 1) increased utilisation of health services and 2) reduction of out-of-pocket expenditure on health services and medication, opening the opportunity to spend this money for other health-related goods such as food, housing, or clothes (20).
Evidence for increased utilisation of health services is more established for vouchers (Meyer et al. 2011) and CCTs (Bastagli et al. 2016; Lagarde et al. 2009) than for UCTs (Bastagli et al. 2016; Pega et al. 2015); however, most studies reporting on 'intermediate outcomes' are outside of humanitarian contexts and care needs to be taken when extrapolating their conclusions.
A systematic review has shown that mass media interventions, for example, "can encourage increased utilisation of health services".
Comorbidities of DM, obstructive lung diseases, or cardiovascular disease among patients with schizophrenia was associated with markedly increased utilisation of GP services than in comparator groups without schizophrenia.
